Life hacks to ring removal
Written by Erena Weathers
You have a nice middle-aged lady, she’s been out and about, and sees a cute ring. She puts it on and goes about her day. She hits up some stores, gets some great finds and picks up some almojabanas (the superior cheese bread of Mira Cali) and heads home. She is holding a lot of bags, so she thinks her finger is in pain because of the constricting bags, so she places them on the counter. She looks down and sees:
She is now in fast track, and it’s your job to get this ring off. So what do you do?
First things first, elevate and place ice. Reinforce with the patient that constant elevation is important. So she raises her hand in the air like she doesn’t care with some ice on her finger, and you leave her for 20-30 mins. When you return, the ring is still on and unable to be removed.
Next step, try some soap and water. At this point, most rings should come off, but this little ring is stubborn, so let’s proceed to your next step.
The next step is the “string technique”. You can use string or floss to create a tourniquet distal to the ring to force down the edema as well as guide the ring off. It should decrease the surrounding edema and allow easy passage of the ring.
In the emergency department, we do not have string or floss, we have oxygen masks. You can remove the strap from an oxygen mask/non-rebreather and perform the same technique (see video below):
At this point, this woman’s finger is purple and everything has failed so you run around asking for raptors, and someone gives you theirs with a promise to return them because they be ~pricey~. Raptors have a nifty part that is mean to cut off rings, and works best on soft metals like gold or silver. But be aware, sometimes that piece can break off and almost hit the patient in the eye (thanks reddit for that information).
Your raptors have broken, just like your patient’s faith in your ability to save her finger. So now you’re staring down the end of the road of options.
Now you try the ring cutters provided in the emergency department. These are pretty much hand-powered little saws that require you to manually rotate the blade to slowly saw through metal. It isn’t fun, and the blades are usually dull, making for a lackluster showing. Also if you’re here, and the patient’s in a lot of pain, I would recommend a digital block. Yes, you’re risking losing your neuro exam, but you’re about to be applying a lot of pressure on a tight space on a finger that is already in a lot of pain.
If all of the above has failed, and the patient is glaring at you because her finger is a purple mushroom. what do you do?
You’re calling FDNY. Yeah, you can call maintenance, but they may not have the correct tool so you’re calling FDNY now. How you may ask? 911. Not kidding. Either you or the charge nurse are calling 911, stating you need fire and it’s a non-emergent call. You tell them you’re in XYZ ER and need a Dremel to cut off a ring.
6-8 firefighters will show up with a Dremel, and you can prep for the procedure. You need a kelly clamp to get underneath the ring and place a little metal protective plate. Then one will firefighter will begin sawing through the ring while another pours saline to dissipate the generated heat, hopefully with eye protection, and cut the bad boy off (see below):
So how did we get here. We got here because our patient decided to wear non-soft metal rings. These typically include your titanium or steel rings. It could also be platinum rings, which are sometimes considered soft metal, but due to their density may require high-speed saws to remove (ask me in person about my thoughts on my husband’s ring).
Now we move on to Tungsten rings, which have become popular due to the black coloring. These are very brittle and unable to be cut by usual methods, so instead of cutting, you have to crack them. In the ED, this means using vice pliers to apply lateral pressure to the band to introduce cracks into the ring until it breaks off the patient’s finger. I would recommend eye protection for yourself and the patient as pieces may go flying. If the tungsten ring has a metal inlay, you must first crack the tungsten and then cut the metal inlay.
This same vice grip method is also used for ceramic rings.
References
AliEM Educational Videos. “Ring removal technique: Using an oxygen mask strap.” Youtube. 27 Jul, 2012. https://www.youtube.com/watch?v=DxoAbK5Pc6w
vapeboy1996. “Raptor shears failed while cutting a ring off, potential dangerous situation (piece flew toward the patient).” Reddit. 7 Dec, 2019. https://www.reddit.com/r/ems/comments/e7ckpv/raptor_shears_failed_while_cutting_a_ring_off/
Neil Fosset Design. “Tungsten Ring Removal Technique.” Youtube. 5 Jul, 2015. https://www.youtube.com/watch?v=MVNZmAeAbBs
